Integration of echocardiographic screening by non-physicians with remote reading in primary care

Nascimento, Bruno Ramos; Beaton, Andrea; Nunes, Maria Carmo Pereira; Tompsett, Allison; Oliveira, Kaciane K.B.; Diamantino, Adriana C; Barbosa, Márcia M.; Lourenço, Tainá V.; Teixeira, Isabella M.; Ruiz, Gabriela Zamunaro Lopes; Rios, João Pedro P.; Ribeiro, Antônio Luiz Pinho; Sable, Craig

doi:10.1136/heartjnl-2018-313593

Cited by 47 publications

(52 citation statements)

References 20 publications

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“…Health professionals working in remote and resource-limited places will benefit from the development of digital and web-based tools to access expert advice through teleconsultations on diagnostic tools [158], such as electrocardiogram [159] and echocardiogram [160]. Mobile health interventions, such as the use of text messaging, can also be useful for both health professionals in the care of CD patients and for improving the adherence of patients to clinical care [161].…”

Section: Registries Information Technology and Digital Healthmentioning

confidence: 99%

WHF IASC Roadmap on Chagas Disease

et al. 2020

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Background: Chagas Disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, with some of the most serious manifestations affecting the cardiovascular system. It is a chronic, stigmatizing condition, closely associated with poverty and affecting close to 6 million people globally. Although historically the disease was limited to endemic areas of Latin America recent years have seen an increasing global spread. In addition to the morbidity and mortality associated with the disease, the social and economic burdens on individuals and society are substantial. Often called the 'silent killer', Chagas disease is characterized by a long, asymptomatic phase in affected indivi duals. A pproximately 30% then go on develop chronic Chagas cardiomyopathy and other serious cardiac complications such as stroke, rhythm disturbances and severe heart failure. Methods: In a collaboration of the World Hearth Federation (WHF) and the Inter-American S ociety of Cardiology (IASC) a writing group consisting of 20 diverse experts on Chagas disease (CD) was convened. The group provided up to date expert knowledge based on their area of expertise. An extensive review of the literature describing obstacles to diagnosis and treatment Echeverría et al: WHF IASC Roadmap on Chagas Disease Art. 26, page 2 of 31 of CD along with proposed solutions was conducted. A survey was sent to all WHF Members and, using snowball sampling to widen the consultation, to a variety of health care professionals working in the CD global health community. The results were analyzed, open comments were reviewed and consolidated, and the findings were incorporated into this document, thus ensuring a consensus representation. Results: The WHF IASC Roadmap on Chagas Disease offers a comprehensive summary of current knowledge on prevention, diagnosis and management of the disease. In providing an analysis of 'roadblocks' in access to comprehensive care for Chagas disease patients, the document serves as a framework from which strategies for implementation such as national plans can be formulated. Several dimensions are considered in the analysis: healthcare system capabilities, governance, financing, community awareness and advocacy. Conclusion: The WHF IASC Roadmap proposes strategies and evidence-based solutions for healthcare professionals, health authorities and governments to help overcome the barriers to comprehensive care for Chagas disease patients. This roadmap describes an ideal patient care pathway, and explores the roadblocks along the way, offering potential solutions based on available research and examples in practice. It represents a call to action to decision-makers and health care professionals to step up efforts to eradicate Chagas disease.

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Section: Registries Information Technology and Digital Healthmentioning

confidence: 99%

WHF IASC Roadmap on Chagas Disease

et al. 2020

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“…Nascimento and colleagues1 in Brazil tested the hypothesis that telemedicine interpretation of a focused handheld echo study performed by a healthcare provider with condensed imaging training could improve delivery of cardiovascular care to patients in low-resource areas. Remarkably, echo screening of 299 asymptomatic primary care patients identified significant heart disease in 35%, with a higher prevalence of disease in older patients (figure 1).…”

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confidence: 99%

“…The popularity stems from the ability to rapidly assimilate findings at the bedside into a diagnosis and treatment plan." The study by Nascimento and colleagues1 is remarkable for the number of patients included, having non-cardiologists perform image acquisition, developing a concentrated imaging training programme and using telemedicine for expert image review. They conclude: "Through high-quality cardiac POCUS, the healthcare community world-wide has a promising new resource to diagnose heart disease.…”

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confidence: 99%

Heartbeat: Telemedicine for echocardiography screening

Otto

2019

Heart

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“…In their Heart paper, Nascimento and colleagues7 report results from the PROVAR+ study which prospectively enrolled subjects from two villages in rural Brazil to undergo screening echocardiography using a pocket-sized ultrasound machine, VScan (GE Healthcare, Chicago, Illinois, USA), to evaluate for heart disease. Subjects were in two groups: a screening cohort of asymptomatic individuals with no known heart disease and a referred cohort consisting of adults on the waiting list for a formal echocardiogram.…”

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confidence: 99%

“…Total screening cohort (blue) versus number diagnosed with HD by cardiac POCUS (red). Adapted from Galasko et al (UK)4 and Nascimento et al (Brazil) 7. HD, heart disease; POCUS, point-of-care ultrasound.…”

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confidence: 99%